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Latest & greatest articles for stroke
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The effect of low-dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation. The Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators. Nonrheumatic atrial fibrillation increases the risk of stroke, presumably from atrial thromboemboli. There is uncertainty about the efficacy and risks of long-term warfarin therapy to prevent stroke.We conducted an unblinded, randomized, controlled trial of long-term, low-dose warfarin therapy (target prothrombin (...) -time ratio, 1.2 to 1.5) in patients with nonrheumatic atrial fibrillation. The control group was not given warfarin but could choose to take aspirin.A total of 420 patients entered the trial (212 in the warfarin group and 208 in the control group) and were followed for an average of 2.2 years. Prothrombin times in the warfarin group were in the target range 83 percent of the time. Only 10 percent of the patients assigned to receive warfarin discontinued the drug permanently. There were 2 strokes
and no exclusions after entry. One patient was withdrawn and in 130 treatment was discontinued early. All patients were followed up for three months and were included in the analysis, except the patient who had been withdrawn.Placebo or nimodipine 60 mg was given orally every four hours for 21 days to 276 and 278 patients, respectively. Treatment was started within 96 hours after subarachnoid haemorrhage.Incidence of cerebralinfarction and ischaemic neurological deficits and outcome three months after (...) Effect of oral nimodipine on cerebralinfarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial. To determine the efficacy of oral nimodipine in reducing cerebralinfarction and poor outcomes (death and severe disability) after subarachnoid haemorrhage.Double blind, placebo controlled, randomised trial with three months of follow up and intention to treat analysis. To have an 80% chance with a significance level of 0.05 of detecting a 50% reduction in an incidence
The Canadian American Ticlopidine Study (CATS) in thromboembolic stroke. The Canadian American Ticlopidine Study (CATS) is a randomised, double-blind, placebo-controlled trial to assess the effect of ticlopidine (250 mg twice daily) in reducing the rate of subsequent occurrence of stroke, myocardial infarction, or vascular death in patients who have had a recent thromboembolic stroke. Twenty-five centres entered 1072 patients into the study between 1 week and 4 months after their qualifying (...) stroke. The patients were treated and followed for up to 3 years (mean 24 months). In the efficacy analysis, the event rate per year for stroke, myocardial infarction or vascular death, considered together, was 15.3% in the placebo group and 10.8% in the ticlopidine group, representing a relative risk reduction with ticlopidine of 30.2% (95% confidence interval 7.5-48.3%; p = 0.006). Ticlopidine was beneficial for both men and women (relative risk reductions 28.1%, p = 0.037, and 34.2%, p = 0.045
1989LancetControlled trial quality: predicted high
persistent focal cerebral or retinal ischemia. Follow-up lasted for two to six years. The three-year event rate for nonfatal stroke or death from any cause was 17 percent for ticlopidine and 19 percent for aspirin--a 12 percent risk reduction (95 percent confidence interval, -2 to 26 percent) with ticlopidine (P = 0.048 for cumulative Kaplan-Meier estimates). The rates of fatal and nonfatal stroke at three years were 10 percent for ticlopidine and 13 percent for aspirin--a 21 percent risk reduction (95 (...) A randomized trial comparing ticlopidine hydrochloride with aspirin for the prevention of stroke in high-risk patients. Ticlopidine Aspirin Stroke Study Group. We report the results of the Ticlopidine Aspirin Stroke Study, a blinded trial at 56 North American centers that compared the effects of ticlopidine hydrochloride (500 mg daily) with those of aspirin (1300 mg daily) on the risk of stroke or death. The medications were randomly assigned to 3069 patients with recent transient or mild
was maintained for seven days. A plain computed tomographic scan was obtained in all but 37 patients. 87% of the strokes were infarcts and 13% were haemorrhages. After six months the numbers of dead or severely disabled patients were equally distributed in the two treatment groups, and this was true also within the ischaemic and haemorrhagic subgroups. Furthermore, haemodilution did not improve outcome either in the group with very recent ischaemicstroke (less than 6 h) or in the subgroup with highest (...) Haemodilution in acute stroke: results of the Italian haemodilution trial. Italian Acute Stroke Study Group. In a multicentre clinical trial 1267 patients with hemispheric stroke of duration 12 h or less and haematocrit of 35% or more were prospectively randomised to either haemodilution (by venesection and replacement of the same volume of dextran 40 in saline solution) or control treatment groups. In the haemodiluted group mean haematocrit declined from 43% to 37% at 48 h and this fall
A controlled trial of nimodipine in acute ischemicstroke. Recent investigations suggest that increased cellular calcium concentrations may be implicated in neuronal death after ischemia. To determine whether treatment with a calcium-channel blocker would improve survival and neurologic outcome in acute ischemicstroke, we enrolled 186 patients in a prospective, double-blind, randomized, placebo-controlled trial of nimodipine (30 mg every six hours), begun within 24 hours of the onset (...) of symptoms of an acute ischemicstroke. During the four-week treatment period, mortality from all causes was significantly reduced with nimodipine as compared with placebo (8 deaths [8.6 percent] vs. 19 [20.4 percent]). The improvement in survival was restricted to men. During the follow-up period of six months, an additional eight patients in each group died. A significantly better neurologic outcome, as assessed by the Mathew scale of neurologic deficit, was also observed in the nimodipine group
Is the pharmacological treatment of mild to moderate hypertension cost effective in stroke prevention? Is the pharmacological treatment of mild to moderate hypertension cost effective in stroke prevention? Is the pharmacological treatment of mild to moderate hypertension cost effective in stroke prevention? Malcolm L A, Kawachi I, Jackson R, Bonita R Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains (...) .) 1) Side effects of therapy are discussed but not included. 2) The costing methodology based on macro usage of health resources is of uncertain accuracy. 3) The paper makes a deliberately optimistic appraisal of therapy, in addition the type of model used is likely to be inaccurate, assuming a constant cost/benefit stream. Bibliographic details Malcolm L A, Kawachi I, Jackson R, Bonita R. Is the pharmacological treatment of mild to moderate hypertension cost effective in stroke prevention? New
Double-blind randomised trial of Org 10172 low-molecular-weight heparinoid in prevention of deep-vein thrombosis in thrombotic stroke. In a double-blind, randomised trial Org 10172 low-molecular-weight (LMW) heparinoid was compared with placebo in the prevention of deep-vein thrombosis in patients with acute thrombotic stroke. Prophylaxis was started within 7 days of the onset of stroke with a loading dose of 1000 anti-factor-Xa units intravenously followed by a fixed dose of 750 anti-factor-Xa
1987LancetControlled trial quality: predicted high
Double-blind randomised trial of intravenous glycerol in acute stroke. The effects of intravenous glycerol in elderly patients with recent onset of acute ischaemicstroke were evaluated in a double-blind randomised controlled trial. 173 patients received either 500 ml of a 10% solution of glycerol in physiological saline or 500 ml of physiological saline administered intravenously over 4 h daily for 6 consecutive days. The number of deaths within the first week was 10 (12%) in the glycerol
1987LancetControlled trial quality: predicted high
The European Stroke Prevention Study (ESPS). Principal end-points. The ESPS Group. In a multicentre double-blind trial, 2500 patients with a clinical diagnosis of a recent cerebrovascular event of atherothrombotic origin (transientischaemicattack, reversible ischaemic neurological deficit, or stroke) were randomised to receive either dipyridamole 75 mg plus acetylsalicylic acid 325 mg (DP-ASA, 1250 patients) or placebo (1250 patients) thrice daily. Follow-up was twenty-four months (...) . On intention-to-treat analysis, 473 patients reached an end-point (stroke or death from any cause), 190 on DP-ASA and 283 on placebo. Survival curves for end-points showed 33% benefit in favour of the DP-ASA group (p less than 0.001). 108 patients died in the DP-ASA group and 156 in the placebo group (p less than 0.01). Results of an explanatory analysis were similar.
1987LancetControlled trial quality: predicted high
Is a controlled trial of long-term oral anticoagulants in patients with stroke and non-rheumatic atrial fibrillation worthwhile? A controlled randomised trial large enough to assess the value of anticoagulating stroke patients in atrial fibrillation would be difficult to conduct in the UK and the results would be applicable to only a small proportion of stroke patients. It would be more worthwhile to organise a trial that also assessed the value of other treatments that are simpler (...) and applicable to all stroke patients. A trial that assessed the value of aspirin and beta-blockers against control in all stroke patients would not cost much more than one restricted to comparing anticoagulants against control in patients with stroke and atrial fibrillation but would provide information of more relevance to the management of patients with stroke in the UK.
Controlled trial of a home-care service for acute stroke patients. In a controlled trial of a home-care service available for the first 6 months after acute stroke, 440 patients received the new service and 417 patients were in the control group. The trial group used more hospital bed days, had a slightly higher admission rate, and did not show better emotional adjustment to stroke than the control group. There was no difference between the 2 groups in stress on relatives. Functional recovery
Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemicstroke. Results of an international randomized trial. The EC/IC Bypass Study Group. To determine whether bypass surgery would benefit patients with symptomatic atherosclerotic disease of the internal carotid artery, we studied 1377 patients with recent hemisphere strokes, retinal infarction, or transientischemicattacks who had atherosclerotic narrowing or occlusion of the ipsilateral internal carotid or middle (...) -Haenszel chi-square = 4.74), and those with persistence of ischemic symptoms after an internal-carotid-artery occlusion had been demonstrated (n = 287, chi-square = 4.04). This study thus failed to confirm the hypothesis that extracranial-intracranial anastomosis is effective in preventing cerebralischemia in patients with atherosclerotic arterial disease in the carotid and middle cerebral arteries.
Effectiveness of speech therapy for aphasic stroke patients. A randomised controlled trial. Aphasic stroke patients were randomly allocated to either a speech therapy group receiving treatment twice a week for 24 weeks or a no-treatment control group. Patients in both groups improved and there were no significant differences in language recovery between the 104 patients allocated to the treatment group and the 87 allocated to the no-treatment group. This treatment regimen, which (...) is representative of clinical practice, is ineffective for most aphasic stroke patients.
Nortriptyline treatment of post-stroke depression: a double-blind study. The efficacy of nortriptyline in the treatment of post-stroke depression was assessed by a double-blind study in thirty-four patients. Half of the patients had major depression. There was a significantly greater improvement in depression in patients treated with nortriptyline than in a similar group of placebo-treated patients. Depression was measured by the Hamilton depression scale, Zung depression scale, present state (...) examination, and an overall depression scale. Successfully treated patients had serum nortriptyline levels in the therapeutic range. Post-stroke depressions are common, severe, and longstanding, and the demonstrated efficacy of nortriptyline provides an important addition to the treatments available for stroke patients.
Randomised trial of pentoxifylline versus acetylsalicylic acid plus dipyridamole in preventing transientischaemicattacks. In a multicentre trial to compare the ability of a combination of acetylsalicylic acid and dipyridamole (1050 mg + 150 mg/day, group A) to prevent recurrence of transientischaemicattacks (TIA) with that of pentoxifylline (1200 mg/day, group B), 36 patients received the combination and 30 pentoxifylline. There was no statistically significant difference between the groups (...) as regards age, sex, blood pressure, site of origin of TIA, and incidence of other risk factors. The incidence of recurrent TIAs during 1 year of follow-up was 28% in group A and 10% in group B; this difference was significant (p less than 0.05). The incidence of permanent strokes was similar in the two groups but distinctly lower (4.5%) than that usually reported after untreated TIA.
A randomized trial of aspirin and sulfinpyrazone in threatened stroke. The Canadian Cooperative Study Group. Five hundred and eighty-five patients with threatened stroke were followed in a randomized clinical trial for an average of 26 months to determine whether aspirin or sulfinpyrazone, singly or in combination, influence the subsequent occurrence of continuing transientischemicattacks, stroke or death. Eighty-five subjects went on to stroke, and 42 died. Aspirin reduced the risk (...) of continuing ischemicattacks, stroke or death by 19 per cent (P less than 0.05) and also reduced risk for the "harder," more important events of stroke or death by 31 percent (P less than 0.05), but this effect was sex-dependent: among men, the risk reduction for stroke or death was 48 per cent (P less than 0.005), whereas no significant trend was observed among women. For sulfinpyrazone, no risk reduction of ischemicattacks was observed, and the 10 per cent risk reduction of stroke or death
Low-dose heparin as a prophylaxis against deep-vein thrombosis after acute stroke. A trial of subcutaneous low-dose heparin in the prevention of deep-vein thrombosis was carried out in elderly patients admitted to hospital after an acute stroke. A statistically significant reduction was observed in deep-vein thrombosis as assessed by isotope leg scanning.
Double-blind trial of glycerol therapy in early stroke. The effects of intravenous glycerol and intravenous dextrose were compared using a double-blind trial in twenty-seven patients with acute stroke. Administration continued for up to 6 days. A standard scoring system was used for neurological evaluation. There was no difference in mortality or in improvement in neurological score between the two groups.
Controlled trial of glycerol versus dexamethasone in the treatment of cerebral oedema in acute cerebralinfarction. 10 percent glycerol was given for 6 days to 30 patients who had had acute ischaemiccerebralinfarction, and the results were compared with those obtained after treating 31 similar patients with dexamethasone (16 mg. per 24 hours for 6 days). 1 patient treated with glycerol died of haemoglobinuria and acute renal failure. 6 patients treated with dexamethasone died--3 from cerebral (...) oedema and 3 from non-neurological complications (pulmonary embolism, myocardial infarction, and aspiration pneumonia). Improvement was significantly greater in the glycerol group after 8 and 15 days. No improvement was noted using either glycerol or dexamethasone in 7 patients with spontaneous intracerebral haemorrhage.